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Health Care Current – September 23, 2014

My Take: Consumer Engagement: Is Less More?

I was lucky to be able to attend TEDMED 2014, held in Washington, D.C., September 10-12 at the Kennedy Center. I have been to more conferences than I can remember, but this one is really different and, without question, a lot of fun (and no, no drum circles, but yoga was offered). It was not just the music and other performances, the international and diverse mix of participants or the extraordinarily healthy food that made this conference different. What I probably liked best was having the chance to quiz and learn from the many innovators presenting their ideas in the Hive, a tent that was full of activity.

As I walked around the Hive, a trend began to emerge. I saw examples of health care products, many using mHealth applications and others using other technologies to collect consumer data so that providers could use it to monitor and manage care. Several speakers even talked about their inventions in this area.

In thinking about the range of technologies I encountered, they seemed to fall along a spectrum of consumer engagement. Some required little input from consumers while others required extensive interaction. Health care experts tend to hold two schools of thought in this area: One school of thought is that consumers who learn about their conditions will become “activated” and excited to take charge of their condition as informed patients. The other school believes that we don’t need to have consumers highly engaged in their care—perhaps the data can just come from them, and they don’t have to do much to produce it.

When I worked with a large, consumer-focused organization five years ago, there was enormous interest in the potential for personal health records (PHRs). These fall squarely in the first school of thought. As I listened to proponents describe the features of PHRs at the conference, I couldn’t help but stack up those exciting concepts with the reality of my personal experience of being a busy mother of two, working full time, with lots of experience helping my mother, her friends and a variety of other older folks navigate Medicare, Medigap and the rest of the health care system. I couldn’t picture myself, much less my mother, taking the time to document all the interactions with the health care system – it just seemed like too much work.

So it was with great interest that I listened to the presentation from Josh Stein, a “serial entrepreneur,” who said something squarely in-line with the second school of thought that really resonated with me. He said that some of the best ideas in the new technologies do not require patients or consumers to become actively engaged. Instead, the technologies take on as much of the job as possible. Josh’s company, AdhereTech, has invented a “smart pill bottle” that uses cell-phone technology to monitor whether patients are taking their medications. And when they forget, the system sends a text or calls to remind the patient to take the medication. Josh also talked about the Internet of Things (IoT) where things like this smart pill bottle might connect to other things (knees, other apps, refrigerators, electronic health records) to create data that could help a physician and care team remotely track a patient’s care pattern over time. The overall patient data could then be used to gain new insights on how people respond to therapies. Ultimately, this technology could lay the groundwork for better technology and care.

This presentation made me think that one aspect of mHealth is how much it makes the patient do. In my opinion, the less a technology makes people do, the more likely it will be in successfully getting the information into the hands of those who can use it to realize the potential for the IoT. On the other hand, I am happy to be proven wrong, as I love the vision of activated patients taking charge of their own conditions.

Two other examples of innovations I saw at TEDMED 2014 help illustrate examples in these two schools of thought:

MySugr Companion is an app that uses an adorable/irritating monster to help people with diabetes track their blood sugar readings. It also provides reminders and games intended to get users to eat right, exercise and understand their condition. It relies on consumers to enter the information and falls in the first school of thought: one could engage people to manage their diabetes and learn more about it.

By contrast, Ginger.io provides information that comes from a consumer’s smartphone sensors to their physician – patients are passive (after downloading the app, presumably). The technology has three components – the app, behavioral analytics engine and a provider dashboard – and the goal is to allow physicians to track care between visits.

I hope these innovators prove to be very successful. I will watch with interest as these companies work to find the right business models and markets for their products.

Deloitte’s surveys of physicians and consumers are finding that the market is demanding these products; consumers and physicians are beginning to catch on to the value of mHealth. But, while consumers march forward and adopt greater use of mHealth for managing their health improvement goals (44 percent), monitoring and managing health issues (46 percent) or even sending a photo of a health related issue to their provider (55 percent), physicians may not be quite as far along.¹ Our 2014 Survey of U.S. Physicians found that only 24 percent of physicians use mHealth, even though 90 percent of them own smartphones.² At some point, hopefully these two critical components of the health care system will come to agreement on the potential behind innovative mHealth technologies.

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